Coccidioidomycosis in Patients Treated with Dupilumab: A Descriptive Case Series

A Th2-favored phenotype can predispose individuals to symptomatic and disseminated coccidioidomycosis. Dupilumab, which impedes Th2 immunity, is sometimes used adjunctively for disseminated coccidioidomycosis. To determine whether dupilumab alters the clinical course of coccidioidomycosis, we retrospectively reviewed records of 1,561 patients who received dupilumab; 42 had coccidioidomycosis diagnosed from October 6, 2018, through July 16, 2025 (Mayo Clinic [Phoenix, Arizona]). Eleven patients received dupilumab before having symptomatic coccidioidomycosis, and 3 received dupilumab before asymptomatic coccidioidomycosis was identified. Twenty-eight patients received dupilumab after coccidioidomycosis was diagnosed: 16 were asymptomatic and seropositive, without reactivation on dupilumab, and 12 had ongoing symptoms (most eventually resolved). No patients had adjunctive dupilumab treatment. Three patients had disseminated coccidioidomycosis: 2 initiated dupilumab after coccidioidomycosis was diagnosed and 1 before, and each eventually had symptomatic improvement. We did not observe patterns of coccidioidomycosis worsening after dupilumab initiation or an increased prevalence of coccidioidomycosis among patients already receiving dupilumab.